Utilization Management Coordinator- Fulltime

Duties

• Assists with collecting information from patients and families that will help to develop treatment and discharge plans.
• Develops and coordinates an individualized discharge plan for the patient by utilizing treatment team and written chart information to determine the patient's aftercare needs.
• Captures and coordinates with physician individualized discharge planning for patients.
• Conducts reviews and other communications and documentation as required by payor standards to obtain necessary certification to maximize reimbursement.
• Acts as the liaison for both internal and external reviewers.
• Helps to complete aftercare appointments that are within seven (7) days of discharge.
• Performs other duties as assigned.

Knowledge, Skills and Abilities

• Basic understanding of human anatomy, specifically musculoskeletal.
• Proficient use of CPT and ICD-10 codes.
• Excellent computer skills including Excel, Word, and Internet use.
• Excellent organizational skills.
• Plans and prioritizes to meet deadlines.
• Excellent customer service skills; communicates clearly and effectively.
• Able to multitask and remain focused while managing a high-volume, time-sensitive workload.

Requirements

• Bachelor’s Degree in social work, Psychology or related field, preferred.
• One year experience in a medical related field and/or prior authorization experience preferred.
• Experience in a Psychiatric setting.
• Knowledge of healthcare service delivery systems, and third party reimbursement.
• Knowledgeable of Managed Care Environment.
• Reliable and flexible.
• Great customer service and team player.